KHF in collaboration with the Ministry of Health, Strategic Purchasing Africa Research Centre (SPARC), ThinkWell and World Health Organization (WHO) is undertaking phase II of the Payer-Provider Engagements. In 2020, Kenya Health Federation (KHF) spearheaded a Provider-Payer Engagement in the Private Health Sector in Kenya aimed at mediating a cohesive engagement between the providers and payers in the private health sector. This engagement adopted a facilitative approach with a view to having the parties actively engage in identifying the challenges and possible solutions.
The following were noted as key challenges to effective provider-payer engagement in the private health sector in Kenya;
- Inadequate communication and weak channels between the parties.
- Lack of trust between the providers and payers
- Inefficient administrative processes including claims and reimbursement management.
- Inequitable relationships that favour large and urban providers.
- Reimbursement strategies that do not incentivize quality and cost control.
- Lack of collaboration in decision making.
- Limited patient engagement.
Based on the challenges highlighted, KHF has identified the need to engage these players in a deeper dive listening session to better understand the challenges and facilitate their process of designing actionable solutions. Furthermore, there is the need to take a whole system approach seeing that most of the issues identified are not peculiar to the private providers.
This will involve private healthcare providers, public sector providers, government regulatory bodies other insurance providers and beneficiaries. A deeper engagement with all relevant government agencies is also needed. It is to these effects that KHF has reached out to the Strategic Purchasing Africa Resource Centre (SPARC), ThinkWell, the World Health Organization (WHO) and the Kenya Ministry of Health (MoH) to move the Provider-Payer engagement phase II process forward, facilitating stakeholder to develop an action plan to operationalize solutions already proposed and listed above.